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How to Fix It, Part II

Beware of those who would have you fight the alligators
When you really came to drain the swamp.

To fix the American Health Care system, we must start from this simple premise: Health care in America is fundamentally broken.

Proponents tout a million programs across the country as the ultimate savior of American medicine. They are not. Few address the number one problem, the cost of medicine, and none in a meaningful way. My plan takes on cost. U.S. health care will cost two trillion dollars this year or more than $6,600 per person for every man woman and child in the U.S. The President’s plan has no workable solution to reduce that $6,600 per person for every man woman and child in the U.S. and we apparently don’t even treat 41 million of those folks. If we don’t take on the cost, health care will cost $13,000/year for every man, woman, and child in America in nine years. Nine years.

A child born as the President speaks tonight will cost from $5,000 to $8,000 for a vaginal delivery to more than $12,000 for a cesarean delivery. Dramatically more if there are complications. In nine years, when those costs have doubled, that baby will be only in third grade.

“What’s your answer?” President Obama asked.

Here’s my answer, Mr. President. Remember Mark Twain. This plan shows how to redesign the system from scratch. It will work as long as we can keep it out of the hands of the U.S. Congress who would impose new fees on the health care industry as a way to “hold down costs.”

There is no distinctly native American criminal class
except Congress.
— Mark Twain

THE HARPERCARE PLAN
Hey, if the President can name it after himself, why can’t I? This is, after all, my story.

We may have the best or the worst doctors on Earth. I don’t care. We may have the best or the worst insurance clerks on Earth. I don’t care. We may have the best or the worst ambulances on Earth. I don’t care.

Fixing “health care” has nothing, absolutely nothing to do with what doctor lives in your town or how you pay to buy a drug or how you get to the clinic. We’ll handle all those issues after some groundwork.

At its most basic, Health Care has one essential job to do: to heal people. We can ask our Health Care system only to keep people from getting sick or injured and to treat people when they do. No more and no less.

To sculpt an elephant is easy. Take a big rock. Chip away everything that’s not an elephant. To design a health care plan, chip away everything that’s not a white elephant. That means to throw away the insurance companies and the Medicare and the VA. Throw away the free clinics and the Beverly Hills face lifters. Throw away the drug reps and the TV ads.

Start from scratch.

Start from what we actually need to fix. One patient. One disease or injury.

ORGANIZATIONA Commission from Scratch
The HarperCare plan creates a small multi-disciplined Independent Commission to analyze the problem and write the solution. We must hold the group to no more than 12 high ranking people from diverse industries. Why 12? That works for juries, doesn’t it?

A respected doctor

A successful hospital administrator

Some knowledgeable consumers/patients

An investigative journalist

Two triumphant entrepreneurs

A couple of senior engineers who understand Value Analysis

A couple of “Wildcards”

One famous, well-respected, smart guy.

The world listens when Dr. Bill Cosby evangelizes about education; we need the Bill Cosby of medicine.

What Rufus calls “wildcards” and I call loose cannons are the non-stakeholders who bring fresh ideas to the mix. Remember Mark Twain. Congress critters will never come up with a solution. They don’t have the skills or the knowledge or the patience and will not sit on the Independent Commission. Insurance CEOs, most docs, and even consumers all have too many ingrained prejudices. And it is important to leave out the singing pigs.

Build a support staff

CPAs (bean counters) to run the numbers

Researchers

A Value Analysis expert to serve as moderator.

AUTHORIZATION
I absolutely hate the idea of another czar. Unfortunately, this Independent Commission needs political power and ability to effect change.

This political commission must have Cabinet-level appearance and clout.

This Independent Commission must fold in one year.

Congress must have only pass/fail power over the findings.

CHARTER
The HarperCare Independent Commission must decide what diseases and injuries to treat, how to integrate discoveries of new diseases and treatments, how to track patient histories, and how to pay the bills. That’s it. No more. No less.

The HarperCare Independent Commission will craft the plan and draft the Federal and State legislation needed both to authorize the plan and to assure Congress cannot re-engineer it.

PROCESS
The HarperCare Independent Commission will use the two keys to success for designing a new system or product: (1) Use a structured thought process based entirely on function; and (2) Beat on the participants to keep them focused. Commission members must check their pre-judgements at the door. The Independent Commission will use a five-stage process grounded in Value Analysis: Prepare a list of needs, Gather information, Generate concepts and programs, Analyze/Evaluate the programs, and Write the Law.

Many people including the President want to list current state of the art (how the government collects the revenue, who has the best hospital, where patients travel, what costs be shed, and so on) before anything else gets done. That’s where we are now. That technique guarantees tunnel vision. It assures that every President, congressman, insurer, doctor, and consumer will pimp for patching the old existing Checker Cab with some fancy new air conditioning when we really must create a sleek new race car out of thin air.

The Independent Commission must list what the Health Care system must do first. In detail.

They can go gather information about what’s on the ground after building the list, but they must not taint the function list with their prior knowledge of treatments or payment plans.

A. PREPARE NEEDS

1. List required functions (what the Health Care system must do)
a. Use a measurable verb-noun format such as “repair laceration” or “diagnose strep throat.”
b. Generalize the function to “treat accident trauma” or “treat infection.”
c. This will be a very long list but it is crucial that it does not attempt to create a dictionary of illness — rather, it will become an encyclopedia of disease, injury and wellness categories.

3. Decide how alternative therapies will be measured and quantified

B. GATHER INFORMATION

1. List current state of art in prevention
a. How is each disease or injury category typically prevented today
b. What non-traditional prevention techniques are used in each disease or injury category today?
c. What prevention techniques are on the horizon?
d. What prevention techniques have been made obsolete by newer or more expensive ideas?
e. Who is doing it?
f. What could they do?
g. What must prevention not do?

2. List current state of art in treatment
a. How is each disease or injury category typically treated today
b. What non-traditional treatment systems are used in each disease or injury category today?
c. What treatments are on the horizon?
d. What treatments have been made obsolete by newer or more expensive therapies?
e. Who is doing it?
f. What could they do?
g. What must treatment not do?

3. List current state of art in payment
a. How is each disease or injury or treatment paid for today?
b. Who is doing it?
c. What does it cost to pay the bills?

C. GENERATE PROGRAMS

1. What (else) will do the jobs listed in the function list?
a. Look at traditional, nontraditional, outdated, and new treatments
b. Is anyone doing that now? Who?
c. What could their treatment do?
d. What must their treatment not do?
e. What does it cost?

2. Measure and quantify alternatives
a. What are the alternate ways of meeting requirements?
b. What else can perform the desired function?
c. Does it accomplish expected results?
c. What does it cost?

D. EVALUATE PROGRAMS

1. Look at all the methods found in Steps B and C. Look at all the existing doctors office and clinic and hospital practices found in Step C. Which ideas are the best?

2. Develop and expand ideas
a. What are the impacts?
b. What is the performance?
c. What does it cost?

E. PRESENT RESULTS

1. Write the Law

2. Take the new Health Care System to the People.

RESULTS
Remember Mark Twain. If we have the will, 2009 can be the year we find the way.

At the end of this process we will have a 10-page law for a health care system that heals people. We will have a health care system that keeps people from getting sick or injured and to treats people when they do, a health care system that costs just half or less of our 2009 spending nationwide, and a health care system that holds future cost increases to the rate of inflation.

For the record, I have the professional and personal experience to back up this plan. I was born in a hospital and grew up immersed in a hospital auxiliary that my mother chaired. I founded a rural health center and served on the Board of Incorporators of a regional hospital. Harris Corporation trained me in Value Analysis, a process tool I have used successfully to design products and systems.

ObamaCare will, the President said, eliminate insurance caps, cap out of pocket expenses, and mandate additional coverage for Americans with existing health insurance, and create a health insurance exchange with tax credits for those who can’t afford this “lower priced” coverage, all while slowing the growth of health care costs for our families, our businesses, and our government.

A “public insurance option,” like the U.S. Postal Service, “would have to be self sufficient and rely on the premiums it collects.”

Individuals will be required to carry health insurance… businesses will be required to offer their workers health care or to pay a “chip in” penalty. And insurance companies will pay a “modest” fee for their most expensive policies.

According to someone, somewhere, here are some things that don’t work:

Single payer systems

Insurance payer systems

Catastrophic care only systems

HMO systems

High Deductible Health Plan systems

Pay-as-you-go systems

Oh, and an Obama proposal floated earlier wants to add a federal sales tax on soda pop. Health care reform is not about raising revenue, though.

I was right but I did make one mistake. I called the people working on my plan a “committee.” Obviously, they need to be an “Independent Commission” in order to make this thing work. I have changed the text accordingly.

The Administration now has the official "ObamaCare" plan on the White House site.

James Adams wrote in the Union Leader, “Congress will do to health care what it did to the post office ”

“With President Obama going around the country trying to push his plan to reform health care, voters should be skeptical, especially when he says, as he did in Portsmouth two weeks ago, that UPS and FedEx are doing just fine; it’s [his own] U.S. Postal Service that is always having problems.

The problem is that you have the goals wrong. The goal is not, and never has been, to fix health care. The goal is to transform American into a socialist system. That requires nationalized healthcare — just like it requires nationalizing the financial sector, manufacturing, etc. and politicizing the NEA and controlling the newspapers through financial subsidy.

If the goal were to “fix” healthcare, it would have been done a generation ago.